Allergic Rhinitis 1: Pathophys, Symptoms, Non-pharm Flashcards
Allergic Rhinitis (AR)
Affects __-__% of population
10-30%
Allergic Rhinitis (AR)
Which group is the highest prevalence increasing?
School-aged children (due to hygeine hypoth)
We are sterilizing and cleaning a lot more
Immune system not challenged enough to develop immunity
Allergic Rhinitis (AR)
What are the genetic components?
- 30% chance of developing allergic rhinitis if one parent is affected
- 50% chance if both parents are affected
Allergic Rhinitis (AR)
What is AR associated with?
asthma, atopic dermatitis, and food allergies
Allergic Rhinitis (AR)
When will it occur?
after inhalation of an allergen which causes inflammation of the nasal mucosa
Allergic Rhinitis (AR)
What are the 2 types of rhinitis?
- Non-allergic
* Allergic (IgE mediated)
Allergic Rhinitis (AR)
List the non-allergic rhinitis
• Drug-induced
• Hormones (pregnancy, menstruation, hypothyroidism)
• Infection
• Non-allergic rhinitis with eosinophilia syndrome (NARES)
• Other: emotions, vasomotor rhinitis (exercise, cold air),
anatomic abnormalities (nasal septal deviation), food and alcohol, nasal polyps, foreign body, strong odours
Allergic Rhinitis (AR)
List the Drug-Induced Non-Allergic Rhinitis
- ACE inhibitors
- ASA and other NSAIDs
- Cocaine
- Diuretics
- Gabapentin
- Hydralazine
- Oral Contraceptives
- Phosphodiesterase -5 inhibitors (eg. Viagra ®)
- Antipsychotics (eg. Chlorpromazine, risperidone)
- Sympatholytics (eg. Clonidine, doxazocin, methyldopa, phentolamine)
- Topical Decongestants (prolonged use)
Allergic Rhinitis (AR)
List the 3 ways to classify AR
- By pattern of symptoms (old way of classifying)
- By frequency of symptoms
- By symptom severity
Allergic Rhinitis (AR)
Name the 2 types of by pattern of symptoms
- Seasonal: response to seasonal allergens (pollen, grass, etc.)
- Perennial: response to year-round allergens (mold, dust mites, animals, etc.)
Allergic Rhinitis (AR)
List the ways to determine by frequency of symptoms
- Intermittent: < 4 days per week or < 4 weeks at a time
* Persistent: > 4 days per week or > 4 weeks at a time
Allergic Rhinitis (AR)
How to determine when using by symptom severity?
- Mild: no impairments or complications with sleep or daily activities
- Moderate to severe: impairment of sleep or daily activities, including cognition/memory
Allergic Rhinitis (AR) (IgE mediated)
What are the 3 phases involved in allergic reaction?
See picture - The Allergic Cascade
- Sensitization
- Immediate Reaction
- Late Reaction
Allergic Rhinitis (AR) (IgE mediated)
Name the reactions & symptoms - Sensitization
Reactions:
• Allergen first contacts nasal mucosa
• Specific IgE antibodies are produced and bind to mast cells and basophils
Symptoms:
• Asymptomatic
Allergic Rhinitis (AR) (IgE mediated)
Name the reactions - Immediate Reaction
Reactions:
•Allergen re-exposure (occurs within minutes and lasts 30-90 mins)
•Allergen binds to specific Abs on immune cells
•Allergic mediators (histamine, leukotrienes, prostaglandins, TNF-a, kinins) are formed & released
Allergic Rhinitis (AR) (IgE mediated)
Name the symptoms - Immediate Reaction
- Sneezing
- Nasal and palatal pruritus
- Congestion
- Clear rhinorrhea
Allergic Rhinitis (AR) (IgE mediated)
Name the reactions & symptoms - Late Reaction
Reactions:
•Symptoms occur 4-8 hrs after re-exposure
•Migration of basophils, eosinophils, macrophages, monocytes, and neutrophils into the nasal mucosa
•Leads to prolonged symptoms of inflammation, nasal blockages, and chronic ongoing rhinitis
Symptoms:
• Immediate phase symptoms but nasal congestion predominates
Allergic Rhinitis (AR) (IgE mediated)
What are other symptoms?
- Itchy, red, watery eyes (allergic conjunctivitis)
- Itchy throat
- Ear fullness and popping
- Feeling of pressure over the cheeks and forehead
Allergic Rhinitis (AR) (IgE mediated)
List the effect on quality of life
- Lower overall sense of health than those without
- Headache, difficulty concentrating, low mood, fatigue, or sleep disturbance
- Children can present with malaise and fatigue
Allergic Rhinitis (AR) (IgE mediated)
What are the complications?
- Sinusitis
- Otitis media
- Asthma
- Sleep apnea
- Dental overbite and high-arched palate in children due to chronic mouth breathing
Allergic Rhinitis (AR)
List the goals of therapy
- Prevent symptoms by avoiding exposure to allergen(s)
- Alleviate signs and symptoms produced by the allergic response
- Minimize adverse effects of treatment
- Improve quality of life
Allergic Rhinitis (AR)
How to assess AR?
- Identify duration, frequency, and severity of symptoms
- Identify any precipitating factors, allergens, and occupational exposures
- Identify any personal or family history of allergies or atopy
- Identify previous therapies tried and response
Allergic Rhinitis (AR)
When to refer?
- Medications used for > 2 weeks without adequate response
- < 2 years old
- Unable to identify allergen
- Signs and symptoms of otitis media, sinusitis, asthma, COPD, other infections
- Fever, purulent nasal or ocular secretions, facial pain
- Loss of smell/taste
- Recurrent epistaxis
- Unilateral symptoms
- Moderate/severe symptoms in some cases
Allergic Rhinitis (AR)
List the Non-Pharm management
- Environmental controls and trigger avoidance = 1 st step in management
- Nasal saline irrigation
Allergic Rhinitis (AR)
List the Prevention/Trigger Avodiance (RxTx)
***See slide for additional info
- Pollen
- Outdoor molds
- Indoor molds
- House dust mites
- Animal allergens
- Occupational allergens
- Others - avoid tobacco, insect sprays, air pollution, freash tar, or paint; HEPA fitlers
Allergic Rhinitis (AR)
What can nasal saline irrigation do?
- It can reduce symptoms and need to pharmacologic therapy
- Isotonic saline preferred over hypotonic (improves mucociliary clearance)
Allergic Rhinitis (AR)
List the nasal saline products
- NetiPot®
- NetiRinse®
- Hydrasense®
- Normal saline spray
